Mental Health, Substance Abuse, and Intellectual and Developmental Disability

Transcription

1 Mental Health, Substance Abuse, and Intellectual and Developmental Disability Mental Health A mental disorder or mental illness is a psychological pattern potentially reflected in behavior that is generally associated with distress or disability, and is not considered part of the normal development of a person s culture. Mental disorders are generally defined by a combination of how a person feels, acts, thinks, or perceives. The recognition and understanding of mental health conditions have changed over time and across cultures, and there are still variations in definition, assessment, and classification, although standard guideline criteria are widely used. According to the World Health Organization (WHO), over one third of people at some time in their lives in most countries report problems which meet criteria for diagnosis of one or more of the common types of mental disorder (US-DHHS, 2012). Substance Abuse Alcoholism and drug dependence and addiction, known as substance use disorders, are complex problems. People with these disorders once were thought to have a character defect or moral weakness; some people still have this mistaken belief. However, most scientists and medical researchers now consider dependence on alcohol or drugs to be a long-term illness, like asthma, hypertension (high blood pressure), or diabetes. Most people who drink alcohol drink very little, and many people can stop taking drugs without a struggle. However, some people develop a substance use disorder use of alcohol or drugs that is compulsive or dangerous (or both) (CSAT, 2012). Intellectual and Developmental Disability Intellectual disability is a disability characterized by significant limitations both in intellectual functions (reasoning, learning, problem solving), and in adaptive behavior, and covers a range of everyday social and practical skills. The disability originates before the age of 18. Developmental disabilities is an umbrella term that includes intellectual disability but also includes other disabilities that are acknowledged during early childhood. Some developmental disabilities are largely physical issues, such as cerebral palsy or epilepsy. Some individuals may have a condition that includes a physical and intellectual disability, for example, Down Syndrome or Fetal Alcohol Syndrome (AAIDD, 2012). 276 P a g e

2 Daymark Recovery Services, Inc. Daymark Recovery Services, Inc. is a mission-driven, comprehensive community provider of culturally sensitive mental health and substance abuse services. The Daymark goal is for skilled medical and behavioral healthcare professionals to support citizens of all ages and their families with the greatest opportunity for recovery, independence, and the highest quality of life. Daymark is committed to using the most current best practices and effective, research-based treatment programs to assist all citizens working toward achieving optimum health and recovery. Daymark Recovery Services, Inc. currently serves 28 counties across the state of North Carolina. Some services are unique to different facilities. Table 8.1 provides a list of service locations and the services provided. Table 8.1 Daymark Recovery Services, Inc. Services Provided Service Locations Walk-in Crisis Mobile Crisis Psychiatry Services Indigent Medication Program Intensive Substance Abuse Treatment Outpatient Individual and Group Treatment Facility Based Crisis and Detox Treatment Peer Support Targeted Case Management Assertive Community Treatment Team Psychosocial Club House Substance Abuse Outpatient Services Substance Abuse Residential Treatment (30, 60, and 90 days) Psychiatric Evaluation and Medication Administration Facility-Based Crisis and Detox Services Access to all other services in Forsyth County Lexington, NC Davidson County Salisbury, NC Rowan County Concord, NC Cabarrus County Albemarle, NC Stanly County Monroe, NC Union County Winston-Salem, NC Forsyth County Mocksville, NC Davie County King & Danbury, NC Stokes County 277 P a g e

3 Service Locations Walk-in Crisis Mobile Crisis Psychiatry Services Indigent Medication Program Intensive Substance Abuse Treatment Outpatient Individual and Group Treatment Facility Based Crisis and Detox Treatment Peer Support Targeted Case Management Assertive Community Treatment Team Psychosocial Club House Substance Abuse Outpatient Services Substance Abuse Residential Treatment (30, 60, and 90 days) Psychiatric Evaluation and Medication Administration Facility-Based Crisis and Detox Services Access to all other services in Forsyth County Reidsville, NC Rockingham County Wadesboro, NC Anson County Buies Creek, NC Harnett County Raeford, NC Hoke County Sanford, NC Lee County Troy, NC Montgomery County Pinehurst, NC Moore County Archdale, NC Randolph County Asheboro, NC Randolph County Rockingham, NC Richmond County Greensboro, NC Guilford County High Point, NC Guilford County Henderson, NC Vance County Raleigh, NC Wake County Source: DRC, P a g e

4 Collaborative Efforts with Rockingham County Providers Through funding provided by the Kate B. Reynolds Foundation in 2010, CenterPoint Human Services and Daymark Recovery Services collaborated with the Rockingham County Department of Public Health and Dayspring Family Medicine Associates to implement the Global Appraisal of Individual Needs Short Screener (GAIN SS) assessment tool. This instrument is used to quickly and accurately identify patients who may have one or more behavioral health disorders. Utilizing the GAIN SS tool allows clinical staff members, along with substance abuse counselors, to better identify individuals in this target population, make referrals, and provide best-practice interventions to improve both access and quality of health care for those needing substance abuse services. Table 8.2 provides the number of clients screened and actions taken during the fiscal years of and at the Rockingham County Department of Public Health (RCDPH) and Dayspring Family Medicine Associates (DFMA). Dayspring Family Medicine Associates did not participate in the program for fiscal year (services provided in Stokes County). Table 8.2 Global Appraisal of Individual Needs Short Screen (GAIN-SS) FISCAL YEAR RCDPH DFMA Total Number of GAIN-SS Completed* 1, Positive Screenings (3+) Refused Screening Accepted Services 49 7 Referrals to In-house Counselor Referrals Made to Outside Providers FISCAL YEAR RCDPH DFMA Total Number of GAIN-SS Completed* Positive Screenings (3+) 38 0 Refused Screening Accepted Services 15 0 Referrals to In-house Counselor 2 0 Referrals Made to Outside Providers 13 0 Source: RCDPH, 2012; Daymark Recovery Services, Inc., 2012 * Patients present for medical/clinical appointment that completed the two-page screening process. For more information about the Global Appraisal of Individual Needs Short Screen, GAIN SS, visit P a g e

5 Daymark Services Information regarding Daymark Recovery Services, Inc. (DAYMARK) consumers served, services provided, and revenues is described in the following tables and graphs. Information is typically identified by catchment (service) area as follows: Piedmont Behavioral Healthcare (PBH) catchment area consisting of Davidson, Union, Cabarrus, Rowan, and Stanly Counties. CenterPoint Human Services (CPHS) catchment area consisting of Forsyth, Stokes, Davie, and Rockingham Counties. Sandhills catchment area consisting of Anson, Harnett, Hoke, Lee, Montgomery, Moore, Randolph-Asheboro, Randolph-Archdale, and Richmond Counties. Guilford catchment area consisting of Guilford County. Table 8.3 CONSUMERS SERVED FY Catchment Area Unduplicated Consumers Unduplicated Services Piedmont Behavioral Healthcare Care (PBH) 16, ,855 CenterPoint Human Services (CPHS) 9,354 73,829 Sandhills 10,724 88,059 Guilford 256 6,919 Chart 8.1 Undulicated Consumers by Local Management Entity, Chart 8.2 Unduplicated Services by Local Management Entity, Table 8.4 Consumers Served and Service Statistics for FY and FY Catchment Area Unduplicated Consumers FY Unduplicated Consumers FY Percent Increase/ (Decrease) Unduplicated Services FY Unduplicated Services FY Percent Increase/ (Decrease) PBH 17,129 16, % 163, , % CPHS 9,318 9, % 66,153 73, % 280 P a g e

6 Table 8.5 provides the number of consumers served by location in each catchment area. Table 8.5 Consumers Served by Location PBH CATCHMENT AREA County Consumers Served Cabarrus County 3,845 Davidson County 4,056 Rowan County 3,257 Stanly County 1,947 Union County 3,707 County CPHS CATCHMENT AREA Consumers Served Davie County 108 Forsyth County 5,725 Rockingham 3,432 Stokes County 89 County Sandhills CATCHMENT AREA Consumers Served Anson County 742 Harnett County 1,630 Hoke County 591 Lee County 1,361 Montgomery County 747 Moore County 1,190 Randolph (Asheboro) County 2,710 Randolph (Archdale) County 781 Richmond County 972 County Guilford CATCHMENT AREA Consumers Served Guilford County 256 The following charts (Chart ) show the number of unduplicated consumers for the catchment areas. Table 8.6 and Chart 8.6 show the consumers served by gender. Table 8.7 and Chart 8.7 show consumers served by ethnicity. Table 8.8 and Chart 8.8 provide consumers served by disabilities. Table 8.9 and Chart 8.9 show consumers served by age. 281 P a g e

7 Chart 8.3 Unduplicated Consumers for PBH Catchement Area, Chart 8.4 Unduplicated Consumers for Sandhills Catchment Area, Chart 8.5 Unduplicated Consumers for CPHS Catchment Area, Chart 8.6 Consumers Served by Gender, Table 8.6 CONSUMERS SERVED BY GENDER Female 19,003 Male 18, P a g e

8 Table 8.7 Consumers by Ethnicity, CULTURE Unknown (due to incomplete information taken during crisis intervention) Chart 8.7 Consumers by Ethnicity, NUMBER OF POPULATION SERVED White 25,011 African-American 9,153 Hispanic 1,053 Native (American or Alaskan) 413 Asian 151 Multi-racial 243 Other (unlisted, aboriginal Canadian, Native Hawaiian, Pacific Islander, Cambodian) Source: DRS: 2012 Table 8.8 Disabilities Served, Diagnoses* TOTAL CONSUMERS Mental Health (MH) only 22,300 Substance Abuse (SA) only 1,088 Both MH & SA 13,376 Other (not primary MH or SA but those with developmental disabilities, dementia, or other medical complications) 382 Note: Does not account for co-occurring disorders but only primary diagnosis Source: DRS: P a g e

9 Chart 8.8 Consumers Served by Disability, Chart 8.9 Consumers Served by Age, Table 8.9 Consumers Served by Age, AGE CONSUMERS SERVED , , , Patient Satisfaction and Outcomes Executive Summary The following is an executive summary of the outcome of the Patient Satisfaction and Outcomes Survey for each service location this fiscal year (FY) and longitudinally over the past two years. Numbers indicate the overall patient satisfaction and are taken from a 10% sample of all persons scheduled to be seen at each location for the month and 100% of the patients in residential and day programs. Patient satisfaction questions include, but are not limited to, patients overall satisfaction with services and their ability to be in better control of their symptoms and lives. Table 8.10 Cumulative Averages for Each Program Site by Calendar Year PROGRAM SITE AND NUMBER PARTICIPATING CY 2007 CY 2008 CY 2009 CY 2010 CY 2011 DURING CY 2011 SURVEY CRC Kannapolis 97% 96% 98% 98% 100% Richmond 93% 99% Stanly 95% 94% 96% 96% 98% Cabarrus 92% 93% 94% 92% 98% CRC Union 86% 98% Anson 95% 97% Guilford Residential 96% Montgomery 99% 96% 284 P a g e

10 PROGRAM SITE AND NUMBER PARTICIPATING DURING CY 2011 SURVEY CY 2007 CY 2008 CY 2009 CY 2010 CY 2011 Rowan 92% 94% 95% 95% 96% Lee 94% 96% Union 94% 91% 93% 93% 96% Forsyth 90% 91% 89% 92% 96% Rockingham 92% 96% Davidson 96% 94% 90% 92% 96% Moore 97% 95% Harnett 95% 95% New Bridge Academy ( formerly Expeditions) 95% 98% 90% 100% 94% Randolph 97% 94% Hoke 93% 93% CUMULATIVE AVERAGE 94% 94% 93% 94% 96% For the complete Annual Report for Fiscal Year , visit CenterPoint Human Services CenterPoint Human Services (CenterPoint) is a state-mandated Local Management Entity in charge of overseeing the delivery of publicly-funded mental health, developmental disabilities, and substance abuse (MHDDSA) services in Forsyth, Stokes, Davie, and Rockingham Counties. CenterPoint works closely with community partners, advocates, and service providers to address the service needs of the people and communities served. Mission: Through collaborative partnerships we develop, manage, and coordinate services to support those with mental health, developmental disabilities, and substance abuse needs. Vision: We are a model for North Carolina of people in partnership empowering those we serve (with mental health, developmental disabilities, substance abuse challenges) to achieve the lives they choose. Values: We live out our mission with credibility, integrity, accountability, compassion, accessibility, respect, quality, and stewardship. CenterPoint business operations include ACCESS, screening, triage and referral to services, consumer and county needs assessments, service authorizations, timely access to services, funding allocations, System of Care implementation, provider endorsement and monitoring, pharmaceutical Patient Assistance Program, and addressing concerns and complaints of consumers and others. In November 2011, CenterPoint was notified by the North Carolina Department of Health and Human Services, Division of Medical Assistance (DMA), that it had been approved to locally operate the 1915 (b)(c) Medicaid Waiver in Forsyth, Stokes, Davie, and Rockingham Counties. As a waiver site, CenterPoint will manage Medicaid funding through a pre-paid inpatient health plan, as well as state funding, to provide medically 285 P a g e

11 necessary mental health, developmental disabilities, and substance abuse services. This transformation from a fee for service to a managed care model will give CenterPoint the ability to reinvest financial resources that it saves into creating new services to address identified needs and gaps. This marks a monumental shift in the right direction. Consumers will have greater access to higher quality services and CenterPoint will have the ability and duty to morph the system into what best fits local needs," says Betty Taylor, CenterPoint CEO/Area Director (CPHS, 2012 a ). CenterPoint Accreditation: CenterPoint Human Services has national accreditation from Utilization Review Accreditation Committee (URAC) in Health Network, Health Call Center, and Health Utilization Management. For more information about CenterPoint Human Services, visit Rockingham County Mental Health and Substance Abuse Service Providers As our community has grown and evolved, the number and variety of available services have increased, as well. In January 2011, a new category of provider agency, a Critical Access Behavioral Health Agency (CABHA), went into effect for the delivery of mental health and substance abuse services for consumers in our state. The Department of Health and Human Services goals in developing the CABHA designation were to: Ensure that critical services are delivered by a clinically competent organization with appropriate medical oversight and the ability to deliver a robust array of services. Move the public system over time to a more coherent service delivery model that reduces clinical fragmentation at the local level and begins to prepare the provider community for the changes that will be required in a waiver environment. Ensure that consumer care is based upon a comprehensive clinical assessment and an appropriate array of services for the population served. Rockingham County s CABHAs are identified as Daymark Recovery Services, Faith in Families, and Youth Haven. Daymark Recovery Services 405 HWY 65 Wentworth, NC Faith in Families 232 Gilmer St., Suite 206 Reidsville, NC Youth Haven 1309 Coach Road Reidsville, NC P a g e

12 For more information about Critical Access Behavioral Health Agency (CABHA), visit Community members or those involved in education, health provision, business, social services, a religious affiliation, or any position where they are in close contact with others, may meet someone in need of help. That person may need a support group, a professional helper, a treatment program, or a public agency. Table 8.11 provides a directory of the available mental health and substance abuse services and providers in Rockingham County, including our area CABHAs. Table 8.11 Directory of Available Mental Health and Substance Abuse Services in Rockingham County Service Location and Contact Inform AbleCorp; Maxim; Rouse s; Wescare Toll Free TTY A Leap of Faith 614 B Chief Martin Road Madison, NC Burston s Consulting & Counseling Svs, LLC 1117 S. Main Street Reidsville, NC CenterPoint Human Services Toll-Free TTY Central Care Division 907 Williams St. and 722 Miles St. Eden, NC and Daymark Recovery Services 405 HWY 65 Wentworth, NC ACCESS / Screening Triage Referral * Assertive Community Treatment Team Community Alternatives Program * **Child and Adolescent Day Treatment Community Support Team Diagnostic * Intensive In-Home Service Juvenile Justice/Substance Abuse/Mental Health Partnership Mobile Crisis Management Services **Multisystemic Therapy Psychosocial Rehabilitation * Residential Treatment Level II * Residential Treatment Level III 287 P a g e Substance Abuse Intensive Outpatient Treatment * * * * * Therapeutic Foster Care

13 Service Location and Contact Inform Empowered Girls Therapy Home 122 Main St. Reidsville, NC Faith in Families 232 Gilmer St., Suite 206 Reidsville, NC Life Turn Group Home 3008 HWY 150 East Reidsville, NC or NC Mentor 1400 Old Mill Circle, Suite 206 Winston Salem, NC ACCESS / Screening Triage Referral Assertive Community Treatment Team Community Alternatives Program **Child and Adolescent Day Treatment Community Support Team Diagnostic Intensive In-Home Service Juvenile Justice/Substance Abuse/Mental Health Partnership Mobile Crisis Management Services **Multisystemic Therapy * * * * Psychosocial Rehabilitation Residential Treatment Level II * Residential Treatment Level III * Substance Abuse Intensive Outpatient Treatment Therapeutic Foster Care * * * * * * Youth Haven 7921 US HWY 158 West Reidsville, NC Youth Villages 7900 Triad Center Drive, Suite 350 * Greensboro, NC Wes Care Professional Services 221 Bedford St. * * Eden, NC Source: CPHS, 2012 **Indicates that Evidence-Based Practice is embedded within program or that service is Evidence-Based per definition. 288 P a g e

14 Tables provide the number of Rockingham County consumers served and payment sources for Fiscal Years 2010, 2011, and 2012 (through December 2011)*. Table 8.12 Rockingham County Consumers Served and Payment Sources FY 2010 MH MH/DD DD MH/SA SA MH/DD/SA Pending Adult ~ Diagnosis Payment Source Total Medicaid Only 1, ,882 IPRS Only ,236 Medicaid & IPRS Total 2, ,385 Child ~ Payment Source MH MH/DD DD MH/SA SA MH/DD/SA Pending Diagnosis Total Medicaid Only 1, ,256 IPRS Only Medicaid & IPRS Total 1, Total Adult & Child 3, ,678 Source: CPHS b, 2012 Table 8.13 Rockingham County Consumers Served and Payment Sources FY 2011 MH MH/DD DD MH/SA SA MH/DD/SA Pending Total Adult Diagnosis Medicaid Only 1, ,047 IPRS Only ,617 Medicaid & IPRS Total 2, ,056 Child MH MH/DD DD MH/SA SA MH/DD/SA Pending Diagnosis Medicaid Only 1, ,249 IPRS Only Medicaid & IPRS Total 1, ,363 Total Adult & Child 4, ,419 Source: CPHS b, 2012 *Fiscal year runs from 07/01/2011 through 06/30/2012. Current data available through December Total 289 P a g e

15 Table 8.14 Rockingham County Consumers Served and Payment Source FY 2012 (through December 2011) Adult MH MH/DD DD MH/SA SA MH/DD/SA Pending Diagnosis Total Medicaid Only 1, ,451 IPRS Only ,234 Medicaid & IPRS Total 2, ,860 Child Medicaid Only 1, ,025 IPRS Only Medicaid & IPRS Total 1, ,112 Total Adult & Child 3, ,972 Source: CPHS b, 2012 Community Needs The CenterPoint Human Services (CenterPoint) Fiscal Year Needs describes the identified needs within Forsyth, Stokes, Davie, and Rockingham Counties. Needs is crucial for setting priorities, making funding and programmatic decisions, and taking action. CenterPoint is committed to continuing to identify and address gaps and track progress towards meeting the priority needs throughout the year. Introduction MH MH/DD DD MH/SA SA MH/DD/SA Pending Diagnosis MH = Mental Health DD = Developmental Disability SA = Substance Abuse IPRS = Integrated Payment and Reporting System The data submitted for this report is provided based upon findings of the CenterPoint Human Services (CenterPoint) 2011 Needs. The full report describes the identified needs within a four-county area including Rockingham, Forsyth, Stokes, and Davie Counties. For purposes of this report, the data will focus primarily on Rockingham County, but will make some comparisons to the other three counties when such a comparison would add perspective to the identification of a need. CenterPoint s goal as the Local Management Entity (LME) is to align LME actions with community needs, mindful of the possibilities available within the scope of our mission, mandates, and funding. This Needs incorporates feedback from disability and countyspecific focus groups; data from the Division of Mental Health/Developmental Total 290 P a g e

16 Disabilities/Substance Abuse Services (DMHDDSAS), Division of Medical Assistance (DMA), and other reporting systems; data on system performance captured, reviewed, and analyzed by CenterPoint; and input/feedback received over time from multiple advisory groups and the community. Survey input captured from consumers, providers, and community stakeholders through an electronic survey is also presented. Needs are identified based on review, trending, and analysis of benchmarks and progress indicators established by DMHDDSAS and/or by CenterPoint, as well as the other sources named. Plan Development Process Focus Groups CenterPoint has an established system of community/advisory groups that provide input to the organization, i.e., Consumer and Family Advisory Committee (CFAC), Intellectual/Developmental Disability (I/DD) Advisory Committee, CenterPoint Area Provider Council, Disability-Specific Waiver Advisory Committees, and System of Care Community Collaboratives. These groups meet regularly to consider issues of importance regarding system performance and community needs. The diverse membership includes consumers, family members, providers, public agencies, advocates, and other stakeholders. In addition to the feedback received from established groups, 15 disability-, age-, and county-specific focus group meetings were held between July 26 and August 9, 2011, in each of the four counties. Participants included representation from consumers and families, advocates, hospitals, law enforcement, providers, public agencies, and charitable trusts. While each county and disability group identified unique needs, higher priority areas identified across all groups are listed below. Consumer and community education regarding available services and supports Recovery-oriented programs ( Recovery Retreat ) Facility-Based Crisis and/or other specialized services that deter inappropriate use of hospital emergency departments and create access to more clinically appropriate assessment and treatment Culturally/linguistically competent services Housing Employment opportunities Increased number of Spanish-speaking professionals in the network Provider proximity to consumer s home (prioritized in top three for rural Stokes and Davie Counties) Transportation (prioritized in top two needs areas for rural Stokes and Davie Counties and for primarily rural Rockingham County) Childcare (prioritized in top four needs areas for Stokes, Davie, and Rockingham Counties) Homelessness (top issue identified for Forsyth County; unique in priority to the urban area) 291 P a g e

17 Rockingham County Focus Group Identified Needs Rockingham County Focus groups identified the following disability-specific priorities (not listed in priority order): Intellectual/Developmental Disability (I/DD) Needs: Development of additional housing options for adults with I/DD Education regarding access to I/DD services Development of additional services for school-aged children Expansion of post-secondary educational opportunities Expansion of childcare for summer and after-school programs Development of additional employment opportunities Expansion of public transportation for work and recreation, especially in the rural counties Expansion of early intervention services for children aged three to five Mental Health (MH) Needs: Expansion of transportation Education regarding available services Education for paraprofessionals working in the field Establishment of additional inpatient beds Establishment of service continuum for dually diagnosed (MH/SA) Increase screenings to identify children with MH issues Increased options for children stepping down from residential treatment Substance Abuse (SA) Needs: Increased transportation availability Additional service practitioners with SA credentials Increased access to SA services in the rural counties Establishment of additional aftercare housing options In an effort to obtain additional information regarding mental health services, especially for a person in crisis, a four-item questionnaire was completed by the three CABHAs, Annie Penn Hospital and Morehead Memorial Hospital. Results of the questionnaire are available in Appendix D. Survey Responses by County and Rank: To facilitate broad-based consumer and community input, a survey was conducted via , the CenterPoint website, and at kiosks at provider sites staffed with licensed CenterPoint staff providing assistance. Consumers were asked to rank their most pressing concerns. Concerns were ranked with 1 being the most important concern and 10 being the least important concern. Tables provide the responses for Rockingham, Forsyth, Stokes, and Davie Counties are as follows: 292 P a g e

18 Table 8.15 Survey Responses for Rockingham County, 2012 Survey Responses Percentage Priority Rankings* Lack of Transportation 34.0% 1 Childcare 33.3% 2 Availability of Resources 30.6% 3 Waiting List 29.0% 4 Frequency of Services 28.3% 5 Provider Not Close to Consumer s Home 27.1% 6 Housing 24.5% 7 Stigma Related to Mental Illness 22.0% 8 Medical Problems 20.4% 9 Homelessness 19.6% 10 Source: CPHS b, 2012 Table 8.16 Survey Responses for Forsyth County, 2012 Survey Responses Percentage Priority Rankings Homelessness 87.0% 1 Housing 83.7% 2 Stigma 80.0% 3 Medical Problems 79.6% 4 Waiting List 78.3% 5 Childcare 73.3% 6 Lack of Transportation 67.0% 7 Frequency of Services 63.0% 8 Availability of Resources 57.6% 9 Provider Not Close to Consumer s Home 50.8% 10 Source: CPHS b, 2012 Table 8.17 Survey Responses for Stokes County, 2012 Survey Responses Percentage Priority Rankings Provider Not Close to Consumer s Home 37.3% 1 Lack of Transportation 35.0% 2 Stigma 34.0% 3 Childcare 33.3% 4 Availability of Resources 32.9% 5 Waiting List 27.5% 6 Medical Problems 26.5% 7 Housing 24.4% 8 Frequency of Services 23.9% 9 Homelessness 21.7% 10 Source: CPHS b, P a g e

19 Table 8.18 Survey Responses for Davie County, 2012 Survey Responses Percentage Priority Rankings Lack of Transportation 38.0% 1 Childcare 37.7% 2 Provider Not Close to Consumer s Home 37.3% 3 Stigma 30.0% 4 Availability of Resources 29.4% 5 Housing 28.6% 6 Frequency of Services 26.1% 7 Homelessness 26.1% 8 Waiting List 23.3% 9 Medical Problems 22.4% 10 Source: CPHS b, P a g e

20 Summary An emerging theme includes the many available services and supports about which providers, consumers, and the community are unaware. This lack of awareness can mean that an individual in need does not access existing services. Further, underutilization of available services may result in the programs becoming unsustainable. Resolution will require increased provider, consumer, and community communication/education; both are an integral part of the planning and implementation of the Medicaid Waiver scheduled for January The need for a more effective flow of communication to inform stakeholders of available services and supports will be addressed through the Waiver Implementation Plan and CenterPoint s 2012 Communication Plan. This plan lays out the path to enhance CenterPoint s media output, including community meetings; a more accessible and user-friendly website; and the implementation of social media, including a newly created Facebook page. In compiling the information for the needs assessment, a diverse group was invited to provide feedback via an electronic survey and focus group participation. In an effort to increase consumer participation, kiosks and electronic means of participation were available at several community provider agencies. A licensed CenterPoint employee was available to answer questions and assist in completion of the survey as needed. Feedback was gathered from all stakeholder groups, with providers representing the largest group responding. There is an identified need for additional resources to reduce the over-utilization of emergency services and hospital emergency departments. Initial 295 P a g e

21 research has begun on the development of a Facility-Based Crisis Center within the CenterPoint catchment area that could provide appropriate assessment and often direct individuals experiencing crisis to more appropriate services outside of a hospital emergency department. Such a facility would allow a more appropriate option for the provision of assessment and/or treatment for individuals in distress, as hospital emergency departments are not typically staffed or funded to handle these situations. There is also the potential that the flexibility available under the Medicaid Waiver will afford the opportunity to develop recovery-oriented programs such as a Recovery Retreat, which would offer a community setting focused on peer support and recovery. Inclusion of peer support and self-management of symptoms through Wellness and Recovery Action Plan (WRAP) training would be an integral part of this type of program. In Rockingham County, as with Forsyth and Davie Counties, there is a greater than 5% Hispanic/Latino population. There has been a 225% increase in the Hispanic/Latino population of Stokes County, although the numbers are small at 2.6% of the total population. Regarding this population, the numbers indicate a disproportionate ratio of potential consumers in need versus professionals with the ability to serve. The low number of Spanish speaking professionals is based on anecdotal observations; however, it is believed to be accurate across the network. CenterPoint will identify solutions throughout the next year to increase Spanish-speaking professionals in the network, including communication with local colleges, increased visibility and participation in Latino community groups, and the agency-wide cultural competency plan currently in development. While there is a need to effectively address the Hispanic/Latino population, there is an overall urgency to become more culturally competent in all LME functions and throughout the service system. In order to address the growing culturally diverse population, CenterPoint must be a leader in training and development of culturally informed staff and a culturally competent system of services and supports. There currently exist 16 CABHA s within the CenterPoint catchment area. Three are based in Rockingham County. There is a significantly high number of CABHA agencies in CenterPoint s four-county area as compared to other LME s of similar geographic and population size. CenterPoint will be vigilant in the oversight of provider agencies. The high number of providers has its benefits, in that service continuums are available for all age and disability groups served through enhanced benefit MH and/or SA services. Niche providers serve specialty populations ranging from children with dual diagnoses to the criminal offender population reentering the community. At least twenty evidencebased and best practices are currently operational across the network within a variety of settings. The Network Development Plan, to be developed based on results of the Needs, will include information from this Needs, as well as information derived from new specialized software that will help CenterPoint precisely track type, location, and gaps in existing services. As a result, services can be developed and barriers can be addressed, as funding allows, improving overall access to care. A comprehensive Cultural Competency Plan is also in development and, when implemented, will lead to a more culturally informed and culturally competent service delivery system. The following priority areas are identified. It should be noted that these 296 P a g e

22 priorities may change as a result of CenterPoint s transition to a Managed Care Organization (MCO) operating 1915(b) (c) Medicaid Waivers. Education on available services Recovery Retreat Facility-Based Crisis Culturally/linguistically competent services Housing options Employment opportunities Transportation With an MCO managing all funding streams, greater access to data will improve validity of information and will increase CenterPoint s ability to accurately identify needs of individuals in the CenterPoint area. Additionally, the flexibility to develop and sustain alternative programs will allow CenterPoint and its provider network to address needs of the most vulnerable populations (CPHS, 2012). Youth Haven Services, Inc. Owned and operated by Dawn Johnson, CEO and co-owner, and James Tucker, co-owner, Youth Haven Services, Inc. (YHSI) was incorporated in 2001 and opened a single residential facility for young males with diagnosed mental health conditions in Since inception, YHSI has recognized the needs of the community and responded by increasing services each year. Remaining true to its mission, To support the healing of children and families through empowerment and hope, YHSI now offers Comprehensive Clinical s, Outpatient Therapy, Day Treatment, Intensive In-Home services, Respite, Targeted Case Management, Residential Treatment, and Therapeutic and Traditional Foster Care services in both Rockingham and Alamance Counties. In 2010, Youth Haven Servcies, Inc. was identified as a Critical Access Behavioral Health Agency (CABHA) (YHSI, 2012). There are two main components that make Youth Haven, Inc. a unique organization. The first is its commitment to a family-focused approach and ways in which the organization can help the entire family. Often, mental health providers will focus on the identified patient, which for children, perpetuates the fix my child; they are the problem, not me parental stance. YHSI utilizes a structural and strategic family-therapy approach to recruit and treat our families. The family then becomes an engaged, integral part of the therapeutic process and not simply bystanders of the work being done. Secondly, the state of North Carolina allowed two school systems to partner with a CABHA and offer Day Treatment Services. YHSI was awarded the contract for the Burlington and Rockingham County School Systems. This is a unique partnership in the blending of private and public agencies working together to offer optimal educational and mental health resources for children. 297 P a g e

23 Services Provided Comprehensive Clinical Targeted Case Management Outpatient Individual and Family Therapy Medication Management Intensive In-Home Services Day Treatment Respite Services Foster Care Residential Treatment Customers Served Table 8.19 shows customers served from July 2010 through June By the end of fiscal year , Youth Haven Services, Inc. experienced a 50% increase in customer service. By providing additional services, YHSI continues to grow and expand services throughout the Piedmont Region. Clinical Outcomes Table 8.19 Youth Haven Services, Inc. Customers Reported Fiscal Year Number Source: YHSI, 2012 In January 2012, Youth Haven Services, Inc. conducted a random survey of consumer outcomes by utilizing the Vanderbilt Scale. Findings showed that consumers experienced a reduction in symptoms related to Attention- Deficit/Hyperactivity Disorder, Oppositional Defiance and Conduct Disorders, and Mood Disturbance after more than three months in treatment. Table 8.20 provides results of the 2012 survey focused on key service areas. Table 8.20 Youth Haven Services, Inc. Survey Results Outpatient Therapy ADHD Symptoms 73% reported reduction in ADHD symptoms ODD/CD Symptoms 64% reported reduction in ODD/CD symptoms Mood Disturbance Symptoms 67% reported reduction in Mood Disturbance symptoms Intensive In-Home ADHD Symptoms 60% reported reduction in ADHD symptoms ODD/CD Symptoms 70% reported reduction in ODD/CD symptoms Mood Disturbance Symptoms 67% reported reduction in Mood Disturbance symptoms Day Treatment ADHD Symptoms 90% reported reduction in ADHD symptoms ODD/CD Symptoms 90% reported reduction in ODD/CD symptoms Mood Disturbance Symptoms 71% reported reduction in Mood Disturbance symptoms Source: YHSI, P a g e

24 Consumers of Youth Haven Services, Inc. reported 100% satisfaction with Out-patient Therapy and Intensive In-Home, Residential, Respite, and Targeted Case Management services. Eighty-five percent of consumers were satisfied with the Day Treatment Program. YHSI s overall satisfaction rate for quarter one (Q1) was 95%, which is consistent with outcomes over the past four years (YHSI, 2012). For more information about Youth Haven Services, Inc., and the services provided, visit Faith in Families Faith in Families, Inc. is a mental health agency that opened in Reidsville, NC, in Faith in Families (FIF) has a total of five offices that serve the following counties: Alamance, Anson, Caswell, Forsyth, Guilford, Montgomery, Rockingham, and Stokes. The mission of Faith in Families is to be committed to working with families for families. The organization believes that every consumer/caregiver is a major contributor in successful mental health and is necessary in encouraging positive change in the lives of consumers. It strives to provide effective services in a caring, nurturing environment. Faith in Families primary goal is to help children with mental health issues and behavioral problems remain in the home with their natural caregivers. The agency has been effective by collaborating with community agencies and providing parents with necessary skills to manage psychiatric issues. Employees of Faith in Families receive rigorous training to ensure person centeredness, cultural competencies, expertise of mental health disorders, effective crisis response, consumer rights and responsibilities, and much more. Faith in Families offers many continuums of care options for clients. Brief descriptions of those services are listed below. Comprehensive Clinical s Completed as part of the agency s intake process, these assess eligibility for services, current life situations and reasons for referral, functioning ability and symptoms, history of problem and diagnosis, and services needed. Tele-Psychiatry and Medication Management This program allows clients to access psychiatric services through telecommunications technology such as videoconferencing. Outpatient Therapy (OPT) OPT is for clients in need of one-on-one counseling, not hospitalization, and is conducted by a licensed psychologist or licensed social worker. Intensive In-Home This three-to-five-month program is dedicated to the preservation and reunification of families and children (up to age 20) who are at risk of out-of-home placement or are returning from placement due to mental health issues. 299 P a g e

25 Multi-Systemic Therapy (MST) MST is for youth ages who have complex clinical, social, and educational problems. The goal is to reduce juvenile criminal activity and other juvenile delinquent behaviors such as drug use. Community Support Team (CST) CST provides mental health and substance abuse rehabilitation services and support for adults ages 18 and older to help achieve rehabilitative and recovery goals. Mental Health/Substance Abuse Targeted Case Management (TCM) This service is provided for children and adults ages three and older who have a serious emotional disturbance, mental illness, or a substance abuse-related disorder or women who are pregnant with any of these disorders. Clients are assisted in gaining access to necessary care, such as medical, behavioral, or social. Family Foster Care Foster Care involves the biological family, the foster parents, teachers, caseworkers, and other significant persons. This program focuses on the emotional, social, medical, and academic needs of the special needs child and aims to provide stability and permanence for the child(ren) by either reuniting with the biological family, adoption, or emancipation (FIF, 2012). Table 8.21 shows the number of clients who have been served by Faith in Families since The Intensive In-Home Services program has served the most clients at 148 since Table 8.21 Clients Served by Faith in Families, Inc. since 2008 Service Provided Number of Clients Multi-Systemic Therapy 26 Outpatient Therapy 48 Community Support Therapy 100 Intensive In-Home 148 Source: FIF, 2012 Faith in Families has the following certifications: Commission on Accreditation of Rehabilitation Facilities (CARF) Committed to continually improving services, encouraging feedback, and serving the community. Critical Access Behavioral Health Agencies (CABHA) Demonstrates adherence and practice of clinical, training, and quality standards, as well as providing a comprehensive continuum of care for consumers. For more information about Faith in Families, Inc and its services, visit or call (Reidsville location). 300 P a g e

26 References: American Association on Intellectual and Developmental Disabilities (AAIDD).(2012). Retrieved April, 2012 from Center for Substance Abuse Treatment (CSAT).(2004). What is Substance Abuse Treatment? Booklet for Families. DHHS Publication No. (SMA) Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved March, 2012 from CenterPoint Human Services (CPHS a ).(2012). CenterPoint Human Services FY Community Needs. Retrieved April, CenterPoint Human Services (CPHS b ).(2012). Unpublished Raw Data. Provided April, Daymark Recover Services, Inc. (DRS).(2012). Annual Report for Fiscal Year Retrieved April, 2012 from Faith in Families, Inc. (FIF).(2012). Unpublished Raw Data. Provided July United States Department of Health and Human Services (US-DHHS).(2000). Mental Health: A Report of the Surgeon General. Chapter 2: The Fundamentals of Mental Health and Mental Illness pp 39. Retrieved May, 2012 Youth Haven Services, Inc. (YHSI).(2012). Unpublished Raw Data. Provided May P a g e